Need for more nurses
hospital CEOs experienced nurse shortages at their organizations.
â– The federal Agency for Healthcare Research and Quality found that overtime had increased from 3.9% to 5.9% of total hours from 1995 to 2002, while a study by the Institute for Women's
Policy Research linked better pay to lower turnover.
President Bush signed legislation in May 2005 to free up 50,000 visas for foreign nurses, while the Nurse Reinvestment Act of 2002 provided scholarship money and a program designed to increase the number of faculty membersâ another shortage often blamed
for the shortfall in new nurses.
Meanwhile, a study released in late June by the Center for Studying Health System Change indicated hospitals are turning to educational initiatives and competitive compensation to help fill nurse vacancies, and relying less on temporary staffing agencies.
In 1983, in an attempt to rein in Medicare costs, the government changed reimbursements to hospitals from a cost-based system to a prospective payment system. Under the new system, hospitals were paid set rates based on DRGs. The idea behind the change was that by paying flat rates, the government would encourage hospitals to become more efficient, which in turn would save Medicare money.
But after providers began manipulating the payment system by upcodingâin which a hospital would select an incorrect DRG code to obtain greater reimbursementâand by billing Medicare for multiple DRGs for a single patient encounter, the government began to crack down. Then in 1992, physician reimbursements were also switched to a PPS, and the rates were set relatively low, causing an uproar within the physician community that has yet to be quelled.
Earlier this year, the CMS proposed an overhaul of the PPS system, in what the agency described as the "first significant revision of the inpatient prospective payment system since its implementation in 1983." The CMS' public-
and hurt specialty hospitals.
severity, high-profit patients.